Treatment Offers New Hope

The threat of cancer spreading through his body made him fear death. But even if the cancer didn't spread, the Delray Beach retiree knew it could mean the end of his sex life.

About 185,000 men are diagnosed with the disease, and 40,000 die of it in the United States every year. The main treatment for most prostate cancers has been radical prostatectomy -- removal of the prostate.

Although removal of the chestnut-sized gland reduces the chance of more cancer, 50 percent to 80 percent of men who have it done suffer some inability to achieve an erection. Many also suffer incontinence.

For Wexler, 74, a father of five grown children, the news was dire.

"When I heard I had cancer in the prostate, I was climbing the walls," Wexler said. "It was a complete catastrophe to me."

However, in recent years the options have increased. About two out of three prostate cancer patients now choose a procedure called radioactive seed implantation, said Dr. Tim Williams, a radiation oncologist. Surgeons deliver precise doses of radiation to the gland by inserting pellets of radioactive palladium or iodine with needles.

Side effects such as impotence and incontinence are less common with the procedure.

Wexler underwent the operation Friday at Boca Raton Community Hospital while a theater full of 100 doctors watched through closed-circuit television. Most urologists have been trained to surgically remove the prostate or to expose it to beams of radiation, but few have learned the new seed implantation technique. Area hospitals have offered the option for about four years.

Leading the operation was Dr. John Blasko, director of clinical research for the Seattle Prostate Institute. Blasko developed the needle insertion technique used to place the radioactive seeds into the gland, just below the bladder in men.

"I started this in 1985, and so we are the only clinic with 10-year results," Blasko said.

The risk of cancer recurring has been similar to the risk after prostate removal. About 85 percent to 90 percent are cancer-free after five years, Blasko said. After 10 years, 80 percent to 85 percent are cancer-free.

Either general anesthetic or epidural anesthetic can be used. Doctors chose general anesthetic for Wexler.

Through tiny holes in the grid, the doctors placed 31 long needles carrying the seeds. The seeds, with cores made of titanium, were coated with a radioactive isotope, palladium 103. In all, 116 radioactive seeds were deposited, doctors said.

They will remain there for the rest of Wexler's life.

For a few weeks, the radioactivity is strong enough to pose a risk to infants or pregnant women nearby. But the danger passes quickly.

"Palladium's radioactivity drops by 50 percent every 17 days," Yore said. "Usually after three months it has pretty much run out."

The seed implant is one of several options for men with localized prostate cancer. One popular therapy uses radiation beams along with 3-D computer imaging to direct them. That requires daily visits to the clinic for eight weeks.

Another new technique uses a robot to deliver high-dose radioactive probes into the prostate, where they're held for about 10 minutes.

Dr. Bruce Horowitz of the Radiation Oncology Center in West Palm Beach performs that procedure in his clinic. Early research shows similar success rates at cancer prevention and few side effects.

All three treatments are for men whose prostate cancer is confined to the prostate.

For men with cancer that has spread, options are limited to hormone therapy that attempts to slow the pace of the disease.

"The earlier men are diagnosed, the more likely they are to have options," Blasko said. "Men should not be afraid to be examined."

Generally, men should start having rectal exams and a special blood test called a PSA once a year after they turn 50. Men who have a family history of the disease should be examined at 40, Blasko said.

Wexler said he thought he made the right choice.

"Some of my friends had gone through this procedure, and they told me the success rates were very high, and it's less debilitating than going through the surgery," Wexler said. "It's a piece of cheesecake."